Cancer Flashcards
Since chemo drugs target rapidly growing cells, which ones are going to be affected in addition to cancer cells?
Bone marrow- WBCs, RBCs, platelets
GI tract- N/V, diarrhea, dysphagia
Hair
Renal-increased uric acid from destruction of cells can cause damage
Fetuses
Spermatogenesis
What are the 3 drugs that are alkylating drugs?
Cyclophosphamide
Mechlorethamine
Carmustine
Which types of drugs are not specific to cell cycle?
Alkyltaing agents
Platinum analogs
Antibiotic-doxorubicin
(As long as the cell is dividing, these will work)
What is the MOA of alkylating agents?
They alkylate the DNA and cause miscoding, breakage, and crosslinking
What kinds of cells do alkylating agents have the most effect on?
Rapidly proliferating cells- tumor cells, but also GI, hair, and bone marrow
What is a shared toxicity of all the alkylating agents?
Vesication- tissue damage at injection site
What two things do we have to do if we give our patient cyclophosphamide?
Give MESNA and aggressively hydrate
Why do we have to give MESNA and aggressively hydrate when we give our patients the alkylating agent cyclophosphamide?
It gets metabolized down into acrolein which causes hemorrhagic cystitis
What can we give our patient who is taking mechlorethamine to prevent kidney damage?
Allopurinol, since mechlorethamine can cause hyperuricemia due to cell breakdown
Which alkylating agent crosses the blood-brain barrier and would be useful for brain cancer?
Carmustine
What is the MOA of cisplatin?
Cross links DNA and causes it to break
What are the 2 main side efffects of cisplatin
kidney damage
Hearing loss
What should we give with cisplatin?
Give with amifostine to reduce kidney damage
What is the MOA of doxorubicin (the antibiotic)
Intercalates into DNA and destroys DNA
What is the main side effect of doxorubicin?
Cardiotoxicity
What makes the side effect of doxorubicin worse?
Iron
What do you have to give with doxorubicin to decrease its side effect?
Give dexrazoxane becasue it chelates iron and reduces the cardiotoxicity
What are the types of cell-cycle specific drugs?
Antimetabolites (S-phase)
Mitosis inhibitors (M-phase)
Antibiotic-bleomycin (G2-M phase)
What are the antimetabolites?
Methotrexate
6-mercaptopurine
5-fluorouracil
What is the MOA of methotrexate?
Inhibits dihydrofolate reductase
What do you need to give AFTER methotrexate?
Leucovorin
What do you need to give AFTER 6-mercaptopurine?
Leucovorin
What do you need to give BEFORE 5-Fluorouracil and why?
Leucovorin to enhance the binding to thymidylate synthase and increase its activity
What two drugs should you NOT combine with allopurinol?
Azathioprine
6-mercaptopurin
Both drugs get metabolized by xanthine oxidase and allopurinol inhibits XO.
POTENTIALLY FATAL BLOOD DISCRASIAS
Why cant you give allopurinol with 6-mercaptopurin or azathioprine?
Both drugs get metabolized by xanthine oxidase and allopurinol inhibits XO.
POTENTIALLY FATAL BLOOD DISCRASIAS
What cell cycle does bleomycin target?
G2 and M
What is one of the benefits of bleomycin?
Very little immunosuppression
What are the drugs in the mitosis inhibitors class?
Vincristine
Vinblastine
Paclitaxel
What is the MOA of vincristine and vinblastine?
They inhibit polymerization of the microtubule. Cell cycle is stopped in metaphase
What is the MOA of paclitaxel?
Inhibits depolymerization of the microtubules, so they are way too stable and non-functional
What are the side effects of vincristine and vinblastine?
They both have neurotoxicity and myelosuppression, BUT:
Vincristine has more neurotoxicity
Vinblastine has more myelosuppression
What is the side effect paclitaxel?
Severe myelosuppression
What does imatinib (gleevec) inhibit?
the Bcr-Abl fusion tyrosine kinase
Should you do any testing before starting your patient on Imatinib (gleevec)?
Yes, it only works on the Bcr-Able tyrosine kinase, so if they don’t have that translocation, it’s not going to work
What class is imatinib (Gleevec) in?
Tyrosine kinase inhibitors
What drugs are in the growth-factor receptor inhibitors class?
Cetuximab
Erlotinib
Bevacizumab
Should you do any testing before starting cetuximab or erlotinib?
Yes, you need to test for epidermal growth factor receptor (EGFR) expression and mutations, otherwise they wont work
What are the main side effects of imatinib(gleevec)
Fluid retention causing ankle edema and periorbital edema- may need to take diuretics
What is the MOA of bevacizumab, and what is the result of that?
It binds to VEGF and prevents binding to that receptor. This prevents angiogenesis
What are the main side effects of bevacizumab?
Bleeding
Thromboembolism
